August 20, 2014, by studentcontributor

Tips for the wards

JonHi there, my name’s Jon and I’m a fourth-year medic doing Specials at Mansfield at the moment. Equipped with six months and two weeks worth of hindsight, I’m hoping to provide some honest and practical tips to help you make the most of your clinical placements / work experience attachments. Even if you aren’t starting clinicals any time soon, you might as well scroll through. This catalogue of previous shortcomings and avowed ineptitudes will at best inform and at worst serve to amuse.

1. Talk to patients

Take histories. Lots of them. If possible, take all of them. History taking is asking a patient questions to formulate a diagnosis and management plan, and I used to dread it. Nothing’s worse than being stuck with a blank sheet and a blank expression, trying to think of what to ask while the patient sits there staring impatiently at you.

History taking is a vital skill which will either haunt you or serve you wonderfully throughout the rest of your medical career. The ability to take a thorough and focussed history will be a major asset, if not essential, in all of your future placements, as well as exams. If you naturally know which questions to ask and have the Calgary-Cambridge framework entrenched within the essence of your soul, good for you. But if not, you’ll have to work at it, and the best way to get better at it is just by practising and learning from your mistakes.

Once you’ve taken your history, go over which questions you have missed out – what you should have asked – and remember to ask them next time. Presenting your history and discussing it with doctors on the ward is great for highlighting aspects you may have forgotten to ask. The most important point here is understanding the rationale behind each question you are asking to help exclude or support a particular diagnosis. Once you reach that stage, it’s less like going through a checklist and more like solving a puzzle. That’s when it gets challenging, and that’s when it gets fun. Of course, this presupposes some knowledge of common diseases and their presentations, which normally gets covered during tutorials and in weekly lectures, but you’d be surprised by how much clinical knowledge one gains just from being chewed out by a consultant on the wards.

The sooner the process of history taking starts to become an automatism, the sooner you can focus on thinking about possible diagnoses while speaking to the patient. This will then determine which questions you should ask and also help you with presenting your findings later in a clear and structured manner. It took me longer than I’d care to admit before I finally realised this.

2. A little introduction goes a long way

Remember when you were taught to always introduce yourself to patients as a matter of basic courtesy? This applies to doctors and nurses too. It makes a lot of difference, saying good morning and initiating interactions instead of shuffling around uncomfortably in the background waiting to be asked who you are. Staff are more likely to help if you have made the effort to make yourself known, plus being civil just generally improves the working atmosphere. Give consultants an opportunity to acknowledge your existence by introducing yourself and asking if you can join their ward round/theatre/clinic. I used to think it was an unforgivable sin to interrupt a healthcare professional in the midst of doing something. It turns out, they don’t mind too much if you have a good reason for interrupting them. Nurses and doctors appreciate enthusiasm and are more likely to involve you if you actively show it. If you’re still struggling to get the hang of engaging with strangers, observe the foundation year and core trainee doctors. They are experts at tactful interruption. Eventually and with enough practice, this will come naturally to you as well. More from me next week!

Read more of Jon’s tips for the wards in the next post.

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